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Raising the (roll)bar: exploring barriers and facilitators to research translation in US public health
Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.ORCID iD: 0000-0002-7232-9417
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background In public health, implementation science work is crucial to protecting the safety and health of populations. Despite this, such efforts have been extremely limited within the specific public health field of occupational safety and health. The overall aim of this thesis is to examine the concept of research translation, the barriers and facilitators that researchers have faced in translating research to the worker environment, and the process of scaling up an evidence-based agricultural safety program. Additionally, this study will provide an opportunity to adapt the clinically based Consolidated Framework for Implementation Research (CFIR), as well as the Proctor Taxonomy (of implementation outcomes), to occupational safety settings.

The implementation research conducted within this dissertation is focused on a case study in agricultural safety. With an annual fatality rate seven times higher than the all-worker fatality rate, agriculture is one of the most dangerous occupations to work in. Though nearly all aspects of farming can be considered dangerous, tractor overturns claim the greatest number of lives. Rollover protective systems (ROPS) are 99% effective in preventing death and disability in the event of an overturn when used with seatbelts. The ROPS Rebate Program was developed in 2006 to encourage the installation of retrofit ROPS in New York State and has been shown to be effective in this goal and in the long-term goal of reducing overturn fatalities. After expanding to six additional states, the National Tractor Safety Coalition was formed in order to facilitate the scaling up of the ROPS Rebate Programs. The National ROPS Rebate Program (NRRP) was formally announced in June 2017, though implementation of it is currently ongoing. 

Methods This dissertation is composed of five sub-studies which applied a mixed methods approach. Sub-study I consisted of a scoping literature review. Manuscripts were identified through six databases to explore how research translation is discussed among the research community. In addition, the review aimed at assessing the T0-T4 model of research translation (first developed by the National Institutes of Health) as it applies to agriculture, forestry, and fishing safety and health and used knowledge gained through the review to make modifications to this model.

To apply the CFIR and Proctor Taxonomy to agricultural safety settings (sub-study II), a survey was developed to assess the relevance of the constructs included in each framework to the NRRP implementation. The final survey was distributed to members of the National Tractor Safety Coalition. Using the results from this survey, quantitative and qualitative evaluation tools were developed.

Sub-study III utilized a repeat measure survey collected at four time points to capture changes in CFIR and Proctor constructs over time. Correlational analyses were conducted to compare each survey item to three outcome measures: state progress toward securing rebate funding for the Program, farmers intakes into the Program, and completed retrofits

Thirteen individuals participated in qualitative research interviews for sub-study IV; nine of these individuals also participated in follow-up interviews. Interview guides were developed based on the survey results in sub-study III. Grounded Theory Situational Analysis was used to analyze each set of data. 

Sub-study V was developed as a result of missing data from sub-studies III and IV. To conduct this analysis, media reports published about the ROPS Rebate Programs were collected. Discourse analysis for print media was used to assess the media reports in comparison to the ROPS Rebate Program trajectory in each state and nationally. 

ResultsSub-study I led to the development of a modified T0-T4 research translation model, which takes into account the real-life challenges in moving proven innovations into widespread practice. The remaining sub-studies in this dissertation focused in the T3 phase of this model (widespread adoption). Sub-study II led to the identification of 21 CFIR and Proctor constructs that National Tractor Safety Coalition members believed would be important to the NRRP implementation. Sub-study III demonstrated that eight CFIR and Proctor constructs were highly correlated (rho ≥ 0.5) with at least one of the outcome measures (progress, intakes, or retrofits). Two primary themes were developed from the qualitative portion of the study (sub-study IV): 1) the implementation strategy evolved inconsistently across stakeholders, and 2) stakeholder engagement is a function of perceived feasibility and "small wins." Finally, sub-study V identified components of successful media strategies for implementation including diversity in actors and messages, timing, and frequency. In total, sub-studies III-V identified 27 CFIR and Proctor constructs that were relevant to the implementation of the NRRP, 10 of which were identified in more than one study. 

ConclusionsThis dissertation has served to examine, specifically, the implementation of the NRRP, and more generally, the field of implementation science as it applies to occupational safety and health. The methods applied in this study as well as the findings have resulted in: application of implementation frameworks to the field of agricultural safety and health, assessment of the unique challenges associated with initiatives to scale up innovations, assessment of implementation from the perspective of the CFIR and Proctor Taxonomy, and assessment of the use of media advocacy as an implementation strategy. The knowledge gained through this research will be helpful in improving the implementation of the NRRP and in developing implementation science efforts within the specific public health field of occupational safety and health. 

Place, publisher, year, edition, pages
Umea: Umea Universitet , 2019. , p. 150
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2048
Keywords [en]
implementation science, research to practice, scale-up, Consolidated Framework for Implementation Research, Proctor taxonomy of implementation outcomes, evidence-based practices, stakeholder engagement, rollover protective systems, tractor overturns, farm safety, occupational safety, injury prevention
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
URN: urn:nbn:se:umu:diva-163636ISBN: 978-91-7855-105-7 (print)OAI: oai:DiVA.org:umu-163636DiVA, id: diva2:1356174
Public defence
2019-10-25, 9D, 9th Floor, Tandläkarhuset, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2019-10-04 Created: 2019-10-01 Last updated: 2019-10-04Bibliographically approved
List of papers
1. Adapting the T0-T4 implementation science model to occupational health and safety in agriculture, forestry, and fishing: A scoping review
Open this publication in new window or tab >>Adapting the T0-T4 implementation science model to occupational health and safety in agriculture, forestry, and fishing: A scoping review
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2018 (English)In: American Journal of Industrial Medicine, ISSN 0271-3586, E-ISSN 1097-0274, Vol. 61, no 1, p. 51-62Article, review/survey (Refereed) Published
Abstract [en]

Background: Despite much research to develop life-saving innovations for the agriculture, forestry, and fishing workforce, these populations continue to face the highest fatal and non-fatal injury rates in the United States, as many of these solutions are not fully adopted.

Methods: A scoping review was conducted to provide an overview of research to practice efforts in this field. The language used to describe these initiatives, the utility of the NIH T0-T4 model, and the progress along the research to practice continuum were examined.

Results: Fourteen eligible references demonstrated that progress in implementation science is lacking and that there is little consistency in how researchers apply the T0-T4 model; thus, a new model is presented.

Conclusions: Researchers in this field face several challenges when moving from research to practice. While some challenges are addressed with the proposed model, additional resources and infrastructure to support such initiatives are necessary.

Place, publisher, year, edition, pages
WILEY, 2018
Keywords
diffusion, dissemination, implementation, occupational health and safety, research to practice, research translation, T0-T4, widespread adoption
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-143631 (URN)10.1002/ajim.22787 (DOI)000418124000006 ()29114898 (PubMedID)
Available from: 2018-01-29 Created: 2018-01-29 Last updated: 2019-10-01Bibliographically approved
2. Applying the Consolidated Framework for implementation research to agricultural safety and health: Barriers, facilitators, and evaluation opportunities
Open this publication in new window or tab >>Applying the Consolidated Framework for implementation research to agricultural safety and health: Barriers, facilitators, and evaluation opportunities
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2018 (English)In: Safety Science, ISSN 0925-7535, E-ISSN 1879-1042, Vol. 107, p. 99-108Article in journal (Refereed) Published
Abstract [en]

Objectives: Within agriculture, forestry, and fishing safety and health research, little progress has been made to implement evidence-based interventions into practice. Beginning in the early 2000s, much work has been done to address the leading cause of agricultural fatalities: tractor overturns. In this time a Rollover Protective Structure Rebate Program has been developed to assist farmers in installing safety equipment to prevent these fatalities. In the current study, the Consolidated Framework for Implementation Research is adapted so that it may be used to evaluate and improve the scaling up of this intervention. Methods: Each construct specified in the Consolidated Framework for Implementation Research was incorporated into a survey, which was distributed to a 77 member Coalition of agricultural stakeholders. Stakeholders were asked to rate each construct based on how important the individual felt it was to the implementation of the National ROPS Rebate Program on a scale of 1 (not at all important) to 5 (extremely important). Results: Using the mean score for each construct as a starting point, 23 constructs were selected for inclusion in an evaluation tool which will be used, in future studies, to evaluate the implementation of the National ROPS Rebate Program. Conclusions: Though the Consolidated Framework for Implementation Research was designed for use in the clinical setting, this study is a first step in applying it to occupational health and safety. The insight gained through this study will provide a foundation for future work on this initiative, as well as in public health.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Research translation, Implementation science, Widespread implementation, Evaluation
National Category
Construction Management
Identifiers
urn:nbn:se:umu:diva-148705 (URN)10.1016/j.ssci.2018.04.008 (DOI)000432767800010 ()2-s2.0-85046366505 (Scopus ID)
Available from: 2018-06-25 Created: 2018-06-25 Last updated: 2019-10-01Bibliographically approved
3. Key factors for successful implementation of the National Rollover Protection Structure Rebate Program: A correlation analysis using the consolidated framework for implementation research
Open this publication in new window or tab >>Key factors for successful implementation of the National Rollover Protection Structure Rebate Program: A correlation analysis using the consolidated framework for implementation research
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2019 (English)In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990XArticle in journal (Refereed) Epub ahead of print
Abstract [en]

Objectives: On US farms, tractor overturns are the leading cause of death; however, these fatalities are preventable with the use of a rollover protection structure (ROPS). A ROPS rebate program was established in New York in 2006 to address these fatalities. Due to its success, the program expanded to six additional states before being implemented as the National ROPS Rebate Program (NRRP) in 2017. The aim of this study was to evaluate the success of the NRRP implementation using short- and long-term ROPS outcome measures and identify which components of the consolidated framework for implementation research (CFIR) correlate with these outcomes.

Methods: Stakeholders involved in the NRRP implementation were surveyed at four time points, beginning at the time of the NRRP launch and then every six months. These surveys measured 14 relevant CFIR constructs. Correlations between CFIR survey items (representing constructs) and three outcome measures (intakes, funding progress, and retrofits) were used to identify CFIR survey items that are predictive of the outcomes.

Results: Eight CFIR survey items were highly correlated (rho ≥0.50) with at least one of the three outcome measures. These eight CFIR survey items included four constructs: access to knowledge and information, leadership engagement, engaging (in fundraising and funding requests), and reflecting and evaluating.

Conclusions: The results of this study provide important guidance for continuing the implementation of the NRRP. Similarly, these findings can inform the evaluation of other similarly structured implementation efforts and the application of CFIR in a variety of settings.

Keywords
agriculture, consolidated framework for implementation research, correlation analysis, factor, implementation, National Rollover Protection Structure Rebate Program, occupational safety, rollover, safety, scale-up, stakeholder engagement
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-162438 (URN)10.5271/sjweh.3844 (DOI)31365746 (PubMedID)
Available from: 2019-08-20 Created: 2019-08-20 Last updated: 2019-10-01
4. Understanding Stakeholder Experiences Implementing a National ROPS Rebate Program: A Grounded Theory Situational Analysis
Open this publication in new window or tab >>Understanding Stakeholder Experiences Implementing a National ROPS Rebate Program: A Grounded Theory Situational Analysis
(English)Manuscript (preprint) (Other academic)
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Occupational and Environmental Medicine
Identifiers
urn:nbn:se:umu:diva-163615 (URN)
Available from: 2019-09-30 Created: 2019-09-30 Last updated: 2019-10-08
5. An exploration of rollover protective structures (ROPS) rebate program media coverage: strategies for implementation and sustainment
Open this publication in new window or tab >>An exploration of rollover protective structures (ROPS) rebate program media coverage: strategies for implementation and sustainment
2019 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, no 1, article id 1257Article in journal (Refereed) Published
Abstract [en]

Background: Media advocacy plays an important role in public health initiatives, as it can provide vital information to target populations, policy makers, or other relevant stakeholders. Unfortunately, little is currently known about the use of media advocacy to promote occupational safety and health programs. This study explores media coverage related to the Rollover Protection Structure (ROPS) Rebate Programs, which were designed to encourage the use of rollover protection on agricultural tractors, thus reducing the risk of tractor overturn fatalities. The Program’s portrayal in the media, as well as the role that the media has played in implementing and sustaining these Programs.

Methods: Media articles pertaining to any of the state-based or National ROPS Rebate Programs and published between November 1, 2006 and October 31, 2018 were included for review. Discourse analysis was used to understand the messages portrayed by the media and how those messages shaped the outcomes of the ROPS Rebate Programs.

Results: During the study period, 212 unique articles were published about the ROPS Rebate Programs. While these articles all portrayed the ROPS Rebate Programs in a largely positive light, they were used at different stages, from pre-implementation through sustainment of the ROPS Rebate Programs, and to different extents.

Conclusions: Media articles have played an important role in implementing and sustaining the ROPS Rebate Programs. Based on the results of this study, more robust and continuous media coverage are important for the longevity and success of public health programs.

Place, publisher, year, edition, pages
Springer, 2019
Keywords
Rollover protection, Media advocacy, Implementation, Discourse analysis
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Occupational and Environmental Medicine
Identifiers
urn:nbn:se:umu:diva-163613 (URN)10.1186/s12889-019-7586-3 (DOI)000485299600004 ()31510988 (PubMedID)
Available from: 2019-09-30 Created: 2019-09-30 Last updated: 2019-10-03Bibliographically approved

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